stared at the swab as if he couldn’t believe his eyes.
Amy was still confused. ‘What?’ She’d never heard the word. ‘Methaem-’
‘Methaemoglobinaemia. It’s a type of acute anaemia caused by exposure to some sort of poison.’ Joss could hardly take his eyes off the swab. ‘I’ve never seen it before-I’ve only read about it. But some chemicals-some poisons-oxidise the iron in the blood, meaning the blood can’t carry oxygen. That describes exactly what we’ve got here. Chocolate brown blood. I must be right. I can’t think of anything else. Amy, get me Sydney Central. I want to talk to a haematologist. Tell them we want an expert in poisons-the best they have-and I don’t care if you have to wake him up to speak to him. This is urgent.’
His mind was whirring over half-forgotten textbook cases. ‘I’d guess activated charcoal or…’ The article was becoming clearer in his mind as he spoke, forgotten texts somehow dredged up into memory. ‘Do we have any methylene blue?’
‘Methylene blue?’
‘It’s used to treat methaemoglobinaemia-when the blood can’t deliver oxygen where it’s needed in the body. It’s also used as a dye to stain certain parts of the body during surgery.’ What was the chance of having it in Iluka? Damn, why didn’t they have a pharmacy? Though even a normal city pharmacy might not stock this.
Amy shook her head, dazed by the speed and certainty of his diagnosis. ‘Methylene… I’ll check. We’re set up with emergency supplies so if the Bowra doctor’s here she has everything she needs in the drug cupboard.’
‘I think we might have something called that,’ Sue-Ellen said diffidently. ‘If I remember right. Dr Scott-the doctor from Bowra-gave us a list when we opened four years ago. She put all sorts of weird things on the list. I remember the pharmacist who supplied us scoffing and saying she was way out of date, and I think it was the methylene blue he was talking about when he said it.’
Please… ‘Let’s hope you’re right,’ Joss told her. ‘But even if you are, I don’t know the dosage. Amy, get onto the phone. I need a haematologist with paediatric back-up. Now!’
What followed was an example of a medical community at its best.
Within five minutes Amy had a telephone link set up-a conference line with a paediatrician, a haematologist and a pathologist for good measure. They’d all been woken from sleep but their concern was audible through the teleconferencing link from Sydney.
They were fascinated as well as concerned. If we have to have a dangerous illness maybe it’s as well to have an interesting one, Amy thought ruefully. All doors were open to a case of a perilously ill child with an unusual diagnosis.
The case conference was swift, intelligent and concise, and by the time Sue-Ellen had located a dated bottle of methylene blue from the back of the drug cupboard Joss was ready. While everyone held their breath-including the three specialists on the end of the phone-Joss administered fifty milligrams.
Then they waited. They all waited, and the specialists from Sydney stayed on the phone and waited with them. There was no appreciable change but at least Emma didn’t get worse. She was drifting in and out of consciousness, fighting the oxygen mask every time she surfaced. More and more Amy wanted her mother to be there. In her mother’s absence she cuddled the child herself.
After twenty minutes the combined opinion was to wait no longer. Thanking his lucky stars for a comprehensive drug cupboard-and that methylene blue didn’t suffer a use-by date-Joss administered another twenty-five milligrams.
Then they stood back and waited again, and it was the hardest thing-dreadful-to do. To watch and wait as a child fought for life.
And then results.
At first they thought they were imagining it. There was a combined holding of breath, and then they were almost certain. The awful blue was fading. The cyanosis was easing-just a bit, but enough to think that maybe…
Maybe was right. Another few minutes and they were sure. Emma was improving while they watched. The specialists on the end of the phone were jubilant, and so was everyone in the room. Sue-Ellen burst into tears, and it was all Joss and Amy could do not to join her.
Still they watched, but the child’s agitation was settling. Her colour was improving by the minute. Her breathing was easing as the oxygen was finally reaching her blood. The danger was over.
‘Look for a poison,’ the haematologist growled, before disconnecting and returning to his bed. He was a gruff man but there was emotion in his gruffness. ‘She must have eaten something that oxidises the ferrous iron in the blood. Sodium nitrate, maybe? Don’t let the kid go home until you discover the source or you’ll have her back in with another episode, and next time you mightn’t be so lucky. And if anyone’s eating where she’s been eating, get them out of the house until you know where the hell it came from.’
He left them to it and went back to his bed.
There was the sound of a patient’s bell from somewhere else in the nursing home. Life went on. Sue-Ellen made her escape, weeping audibly into her handkerchief, leaving Joss and Amy staring at each other in disbelief.
‘Oh, thank God,’ Amy murmured. Emma was drifting into an exhausted natural sleep, and her colour was almost back to normal. Amy had been cradling her to comfort her distress. Now the child’s lashes had fluttered closed. Amy laid her back on her pillows and gently tucked her in.
‘Do you want to tell her grandparents the good news?’ Joss asked, and by his voice Amy could tell he was as shaken as she had been. Margy and Harry Crammond hadn’t come into the room. They’d stayed out in Reception and panicked in isolation. Their distress had just upset their granddaughter more.
‘You tell them.’ Amy was smiling and smiling. ‘You made the diagnosis.’
‘You noticed the swab.’
‘Together we make a great team.’ Amy’s eyes were bright with unshed tears. She was still holding Emma’s hand but the little girl was slipping into a deep and natural sleep. ‘Off you go. Tell her grandma and grandpa while I watch over her. And, Joss?’
‘Yes?’ He paused at the door and looked back.
‘Thank you.’
‘Think nothing of it.’ His chest was expanding by the moment. The child would live, and it felt great! ‘What else is a doctor for but to save lives? Given nursing staff with the power of observation you seem to have…well, as you say, we make a great team.’
He looked down at Amy and the child. They looked…magnificent. He closed the door behind him before she could see that his own eyes weren’t exactly dry.
There were four people in Reception-Emma’s grandparents, Joss’s father and Daisy.
‘We drove them here,’ David told his son. ‘And then we stayed. Did you really think we could go home before knowing the little one was safe?’
Joss looked at his father with affection. No. He didn’t.
He operated with his heart, did his dad. It got him into all sorts of trouble. He’d buried three wives! His heart had been broken so many times, Joss thought, and each time he surfaced again to set himself up for more heartbreak.
Joss had never understood, but tonight, as he watched his father embrace his friends and celebrate this wonderful news-tonight he saw where his father was coming from.
Sure it hurt to give your heart. But now… This was such jubilation. Maybe…
Maybe what? What was he thinking of?
Was he thinking of giving his heart to Amy?
It wasn’t wanted, he told himself savagely. Amy had a fiance. She had a life. She had nothing to do with him.
‘Can you put Mr and Mrs Crammond up for the night? Give them a bed?’ he asked his father, but he knew before he answered what the response would be.
‘Sure. But why?’ The four elderly people were looking at him now with varying degrees of confusion.
‘Emma ate something she shouldn’t have,’ he told them. ‘You said she had roast meat and veggies and apple pie for dinner. Is that all? Did she eat anything that you didn’t eat?’
